Provider Demographics
NPI:1326317017
Name:DOMINGUEZ, NOELIA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:NOELIA
Other - Middle Name:
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 171537
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33017-1537
Mailing Address - Country:US
Mailing Address - Phone:305-505-9456
Mailing Address - Fax:
Practice Address - Street 1:1825 W 44TH PL
Practice Address - Street 2:APT # 607
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-8410
Practice Address - Country:US
Practice Address - Phone:305-505-9456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-24
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64431225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist